Episode #268: Lessons from the 2023 RIDA Virtual Summit
There’s only one winner in today’s dental insurance system: the insurance company. Dropping out of PPO plans is not only going to be beneficial to you and your team, but it also benefits your patients! The patients get played by the insurance company, which often establishes not-so-patient-centric policies. Here’s where you come in and play a role in ensuring that your patients receive the treatment they are supposed to get. In this episode, Gary will explain how you will massively help your patients by your decision to drop out of PPO plans.
Naren: Hello everyone, welcome to another amazing episode of the less insurance dependence podcast show. This is Naren your co-host. Today we have an exciting podcast, let me just tell you what the topic is and I have an announcement after that. The topic today is "three ways your patients benefit when you drop PPO plans" but before we jump into that, I want to, you know to share with you an announcement. We have an MBA coming up this is the format that all of you love the most it’s a three-evening format so during the week you just take three evenings and you get nine hours of content. It’s April 20th 21st and the 22nd 7 to 10 pm eastern. We have a limited number of seats and if you’re available definitely sign up. You’re going to learn from Gary the 10 elements of the 24 systems and also, you’re going to do 11 exercises. The reason people love this format is every day they get to come to the MBA learn from Gary then think about it and then come back the next day the more they thought about it and came back the next day the more they got out of it as opposed to a full-day event, so take advantage of it this is you know after a very long time we have we’re bringing back this format so don’t miss out and the and the for the amount of CE you get even the price is amazing so take advantage of this opportunity. Now let’s jump into our podcast for the day. Gary this is something that I am very passionate about this idea of fairness. So, today’s topic is three ways your patients benefit when you drop your plans. The reason I mentioned fairness is that you know somebody’s paying for somebody. So, if you’re giving a 44 percent write-off for your pp or patients those patients are getting subsidized by all your other full fee-paying patients. So, it’s not fair for everybody else because of the PPO patients. So, let’s jump in get it three ways your patients benefit when you drop PPO plans?
Gary: you know Naren, throughout this podcast we’ve spoken an awful lot about how dentists benefit when they successfully resign from PPO plans, how team members benefit, but there’s a third piece of the puzzle and that’s your patients, which we need to focus on because ultimately your patient’s response to this is going to have a lot to do with your success of resigning from PPO plans and the reality is, there are some very distinct benefits to your patients when you go out of network and that may sound a little contrarian you think wait a minute this doesn’t benefit my patients, it absolutely does and this will make more sense as you stay with us through this podcast episode but there’s a number of ways that your patients benefit and you know Naren, I always like to run things in my own practice through a simple filter and that is how would it feel if I was a patient, whatever it is we’re going to do
Gary: you know how would it feel if I was the patient you know think about that you know for just a minute, almost any decision that we’re making in the practice, if we run it through that filter it can kind of take us to the obvious choice of you know whatever decision we’re making because ultimately your patient votes with their feet you know in terms of supporting your practice. So, I really think that that’s a useful filter to use you know how would this feel you know if I was a patient and in this case, it really does apply to our topic today which are you know the ways that patients benefit when you go out of network. You know today it’s important for us to recognize that in the dental insurance world there are four entities involved. There’s the dental insurance company that provides the benefits, there’s the dentist who provides the care, the patient that receives the care, and finally the company that bought the policy, the employer that bought the policy. In those four entities today with today’s current PPO system there’s only one winner and that is the dental insurance company
Gary: the other three entities lose the dentist loses because he or she has to pay a massive discount by being a provider in their network. Today that discounts 42 to 44 percent. The patients lose because of all the games the insurance company plays with them. You know heaven forbid your wonderful patient would come in for their second hygiene visit five months and 29 days after the first one because that claim will be stamped denied because they were a day early. You know they have to have a six-month wait and then the employer this is often missed in the discussion, the employer loses who bought the policy, so he might say well how in the world did the employer lose because they are literally being gouged by the insurance companies regarding the premiums that they’re paying their premiums are anywhere from 50 to 70 percent higher than they should be
Gary: and so the employer loses in that situation so the only winner you know is the dental insurance company your patient’s a loser so when you think about that when you think about when you’re participating, your patient’s a loser in that game because of all the games the insurance company plays. There’s you know when you read some of the fine print in those planned contracts Naren.
Gary: it is sobering how many exclusions are listed you know things that aren’t covered
Naren: no I think the biggest problem I see with this is instead of a patient being able to focus on their health they focus on tooth dentistry you know fixing, fixing, fixing, it just and given that mouth is kind of the entryway to your overall health because everything goes through your mouth it creates a wrong precedent, right, I mean if you don’t have healthy mouth healthy gums healthy teeth now you probably are not going to have you know healthy blood sugar levels
Gary: let’s bring this very timely
Gary: to our current, you know covid19 world
Gary: there are many things we don’t know about coven 19. It seems like the things we don’t know often are more than the things we know about it but one thing we do know is that the stronger your immune system is the better prepared you are to fight a virus
Gary: it’s a virus the better prepared the stronger your immune system we can do to strengthen the immune system is going to be helpful when it comes to dealing with the virus-like COVID 19.
Naren: and insurance is not going to pay for you the dentist talking to the patient about their overall health. They’re not going to pay for you talking to them about like you know your immune system and how you know everything is connected. They’re not going to do that there’s no claim for that right there’s nothing to do with improving your health.
Gary: so, it creates a very you know the PPO environment creates very much like a simple fix-it environment.
Gary: where you have this problem, it’s covered by your insurance and we fix it often doesn’t go to the underlying cause it often doesn’t allow the provider to spend enough time truly probing and understanding what caused that issue
Naren: and even fixing it’s like piecemeal fixing right not like fix the whole thing, oh well we’ll do tiny piece whatever the insurance can cover this year
Gary: and it’s really a fix-it model instead of a wellness model
Gary: one of the things that we’re seeing on the medical side today Naren is it’s a small movement now but it’s a growing movement you’ve likely heard about it and they call it different titles I’ve heard it called private practice health care, I’ve heard it called concierge health care
Gary: And the idea is that a physician will work with a certain number of patients
Gary: and essentially be their private physician and the physician’s job is to help those patients become as healthy as possible.
Naren: exactly wellness model being proactive
Gary: Wellness model so instead of the physician
Naren: you’re feeling and how you what you’re eating the whole thing not just oh you’re sick you’re going to die tomorrow let me try to figure it out
Gary: instead of fixing a problem yeah they really get to know their patients and you know we had the I’ll speak on a very personal level here Naren, about a year and a half ago, we had a very personal experience with this when my wife wasn’t happy with her primary care physician and she just felt like she was a spoke in the wheel, you know a number in this office and she just had an underlying feeling that you know she was going having her appointments and she just had the idea that she was simply you know a faceless person on this doctor’s schedule and so she changed her primary to a wonderful primary care physician and this primary care out of network but this primary care physician took the time to ask some questions and in the process of him asking some questions and it was a series of some tests some analytics some blood work in the process of asking some questions, it led to diagnosing her with breast cancer.
Gary: fortunately it was caught very early she had a lumpectomy and followed by radiation therapy and she is now cancer-free and it was caught it was stage one breast cancer and imagine if she would have continued down that path with her previous physician where it was undiagnosed it was unknown, there were no symptoms trees didn’t have any symptoms and yet it was a healthcare provider a physician asking questions and taking time to ask questions that led to that diagnosis and we literally credit her primary care physician today as saving her life. We literally credit him with this
Naren: the only difference between the two doctors is; the first one is just you are a number and nothing about you the human being and your wellness as opposed to the second one it’s all about you being as healthy as possible so he wanted to understand everything and he probed he looked where he needed to look he found out what he needed to find out and boom something thank god that I guess god was you know with Therese that maybe he sent him to this doctor you know where you know like it was almost like
Gary: we literally credit this provider with the early detection we know in cancer that if it can be detected early the treatment is much less invasive and it is typically much more successful
Gary: you know stage one is a different stage of any type of cancer than stage three or four
Gary: and in part of that was just having the time to do that and having a model that allowed humor you know it really allows you to care for your patients in a way you can’t care for your patients is everything’s a procedure code
Gary: you know any insurance companies that have a code for spending time to get to know your patients
Gary: there is no code for that
Naren: there is no code for that and again because they only pay you 45 percent now you have to see double the number of patients which means what gets cut
Gary: It further leads you down the road of the proverbial hamster the on the wheel
Gary: and that that leads you away from spending time with your patients getting to know them better asking the questions that you know how to ask
Gary: but it leads you away
Naren: this is why doctors go to medical school in the first place right I mean they want to take care of people they want to make people healthy. So, it kind of leads you away from the purpose of how you started this journey in the first place.
Gary: I don’t know a single physician that went to medical school to successfully process codes
Gary: Yeah, that’s what it is well let me talk about Naren three ways the very specific ways your patient’s benefit, and remember any time your patients benefit we’re building a better practice
Gary: so here are three ways your patients benefit when you drop PPO plans now I want you to listen very carefully to this first one your fees can be made fairer to all of your patients because your uninsured patients will no longer have to subsidize the fees of the insured patients. Think about that right now and I doubt that many dentists have ever thought about this but right now doctor if you’re a PPO practice, you’ll have a small number of patients who don’t have insurance. Those people pay much higher for the same care in your practice, they’re essentially subsidizing the huge body of patients you have that have insurance and I’ll ask you a question, is that fair to that patient. I mean I’ll give an exam there’s a dentist in our building that I can share very specifically with I won’t use the name but the crown fee is about 1700 Dollars, the UCR crown fee is about 1700 dollars and this dentist is on many, many, many, PPO plans and a typical PPO fee is a contractor fee for a crown is 800 Dollars. So the majority of these practice patients pay 800 dollars the few that don’t have insurance pay 1700 Dollars for the quote the same crown is that fair? Well, when you go out of network you can look at what would be a fair fee, you know what if you decided that wait a minute is it really fair to have you know eighty percent of my patients pay eight hundred dollars and then the twenty percent over here pay seventeen hundred dollars, you might discover that a really fair fee for everyone would be thirteen hundred dollars, I’m making up numbers Naren.
Gary: you get the idea
Gary: and then everybody is subjected to that same fair fee. So, it’s a more fair-way and I think our listeners at least I feel like we get to know our listeners, our listeners are fair-minded. You know they want to be fair
Naren: yeah, I mean imagine I’m just using an example imagine you’re married and your spouse does so much for you but we don’t treat as possible but we treat strangers exceptional well. It’s almost like that here is somebody who’s giving you all the money to run your practice but we treat them you know not in a different way but the same way as the people who are paying us half them it does it’s not fair it just doesn’t make any sense.
Gary: let me go to the second way your patients benefit when you apply an in-office membership plan which there’s plenty of episodes here on the less insurance dependence podcast. So you can learn that when you apply an office membership plan then patients can save money on every procedure in your practice with no limitations or games.
Gary: you know we recommend a 10 savings
Gary: I don’t like to call it discount makes me think of Kmart Walmart but the patient can have 10 savings by being a member of your in-office membership plan, our TLC savings plan our smile your VIP smile savings plan whatever you want to call it and they can save that 10 percent remember we did the testing for you we did the heavy lifting we tested what percent would make the most percent sense to apply to a membership plan we tested 20 percent, 18 percent, 15 percent, 12 percent, 10 percent, and 8 percent, and we discovered that 10 percent, was the sweet spot I don’t like the 10 discount but I like it a whole lot better than the 42 to 44 percent that’s in the PPO plan and then there are no games. If you have an older patient that requires a full mouth reconstruction and that’s a forty thousand dollar treatment, they save four thousand dollars again a great way to benefit your patients and maybe that that last point, we kind of glanced on it but I want to punctuate it here when you go out of network you’ll be able to spend more time with your patients since you and your team members no longer need to pedal like the proverbial hamster on the wheel and I wonder you know what that extra time could benefit from you know I wonder how we could benefit that that patient you know most of the time we don’t think of dentistry as life-saving unlike our colleagues in the ER room every day they’re saving lives
Gary: but in fact, there are ways the dentist can save lives
Naren: and even the I love dentistry community I’ve heard of several dentists who have saved lives
Gary: let me give you an example Naren
Gary: if an office is involved in diagnosing and treating obstructive sleep Apnea um obstructive sleep apnea is an epidemic in the united states an apple absolute epidemic and the interesting thing about it is that for our mid-career and late-career dentist you are typically trained to look for a certain type of patient that might be suffering from obstructive sleep Apnea. It would typically be male middle age and over older, very overweight, and likely with a very large neck however, they look kind of like a football alignment. However, we know now that it can afflict anyone. Your patient could just as likely be a 30-year-old female that’s perfectly proportioned in terms of height and weight with a normal-sized neck but now what if we ask some questions and the questions can take you down a path of getting more information which could end up saving a patient’s life and certainly even if it’s not that dramatic and extreme, spending time with your patients is a very definite patient benefit, very definite patient benefit. Well, I hope we’ve simulate stimulated some thinking for you on this in terms of how going out of network can successfully benefit your patients, and whenever we do something that benefits our patients we make your practice stronger. Hey, I want to take a minute and thank all of you for being a less insurance dependence listener we appreciate each and every one of you three things you can do to support our work. You can tell a colleague about it it’d be fun to have a colleague kind of to go down this journey within reducing insurance dependence secondly you can write a review on iTunes. Review on iTunes will help more dentists find us and third be sure to hit the subscribe button you can do it on iTunes google play you can do it on Spotify apple music amazon music or wherever you get your podcast if you hit subscribe it’s free it simply means that every Thursday when we upload a new episode it’ll be automatically uploaded to your listening device. Thanks, we look forward to connecting with you on the next lesson insurance dependence podcast.